Death with Dignity paper

Running head: DEATH WITH DIGNITY Lutz1

Death with Dignity

Katelyn J. Lutz

Alvernia University

DEATH WITH DIGNITY Lutz 2

The Death with Dignity laws are accepted in the states, Oregon, Washington, Vermont,

Montana and New Mexico. These laws allow for terminally-ill, but mentally competent adults

who reside in these states to volunteer to request and receive a prescribed medicine to quicken

their death. Oregon was the first state to approve this law in 1994 then later confirming their

support in 1997 which is when it went into effect as The Oregon Death with Dignity Act. After

that, Washington voters had the law passed in 2008 and implemented in 2009 and in 2013

lawmakers in Vermont portray their assisted death law as it was passed through legislation.

Patients who want to go through with this action have to be qualified to do so and have a

licensed physician caring for their needs to implement these laws on each and every patient since

every single one has different issues and needs. (Contemporary catholic health care ethics (2nd

ed.)).

Eligibility

Patients who are terminally-ill and who wish to access a prescription under the Oregon,

Washington, Vermont, Montana or New Mexico law, are eligible as a resident in one of those

states. Other requirements for physician-assisted suicide are that a patient must qualify for is they

need to be eighteen years or older and they have to be capable of communicating and making

competent health care decisions on their own. Lastly, the patient must have been diagnosed with

a terminal illness that will lead to their death within or less than six months. (Death with Dignity

National Center, 2014).

Patient’s Residency

To be able to be prescribed any sort of medication to hasten death, the patient must be

able to provide their physician a proof of residency according to that state’s laws and there is no


timetable associated with establishing any residency. There is no minimum residency

requirement as long as the patient can simply prove they are a current, legitimate resident of

Oregon, Washington, Vermont, Montana or New Mexico. A state issued ID like a driver’s

license, documents showing that the patient owns or rents property in one of the five states, a

voter’s registration, or recent state tax return are all types of proof that a patients can use in the

application process. After this, the physician in charge must make a decision on if the patient has

properly and appropriately established residency. A person can move to one of the five states

where physician-assisted suicide is legal, but reports have shown that not many people have

chosen to make the move. (Death with Dignity National Center, 2014).

Request Timeline

Following, are the steps a patient must go by to use the law: an oral request must be made

to the physician, a fifteen day waiting period, then a second request to the physician. After the

second request, a written request needs to be made to the physician, then forty-eight hour waiting

period before the prescribed medicine can be picked up, after that, the patient is bale to pick-up

their prescription at the pharmacy. (Boyce, J., 2012).

Protecting all Citizens

Patients are protected by safeguards and if the law is used then they are in full control of

their process and that there are no chances that the patients are forced to their death. The

terminally-ill patient is required which are: to verbally request the medication from the physician

twice and each one is separated by the fifteen days. They make a written request to their

physician and that request is also witnessed by two other individuals who cannot primarily be

family members or caregivers. The patient can cancel any verbal and written request during any


time. The patient wishing to access their rights under the law also must be able self-administer

and consume the medicine prescribed. The physician in charge of the care for the patient must be

licensed in the same state as the patient and the physician’s diagnosis has to include that the

patient with the terminal illness has six months or fewer to live. The diagnosis must also be

certified by a consulting physician who has to certify that the patient is indeed mentally

competent to communicate and make such decisions on their health. In any case that the

patients’s judgments are impaired, the patient must be referred for a psychological examination

and the attending physician must inform the patient about alternatives like pain management or

hospice options and that physician has to request that the patient inform their closest family

members about the prescription request. The attending physician is responsible for reporting

every prescription to the state. Lastly, under the law, the patient’s life insurance policies and

status of their health in regards to the health care system, the physician is obligated to participate

in the Death with Dignity laws. (Boyce, J., 2012).

The Evolving State of Physician-Assisted Suicide

The question, “Should terminally ill patients have the right to kill themselves?” is often a

questioned asked when it comes to discussion about Death with Dignity laws. Since Oregon

gained the right to these laws, over nine-hundred patients have chosen to exercise their rights

under the right to use the law, although not all have taken the prescription given to them and

instead “just deal” with their illness. The medicine used and self-administered by the patient is

called Seconal, a barbiturate that is also prescribed by doctors to treat insomnia or to calm

patients before getting surgery. The capsule contents are stirred into water or applesauce. The

Oregon Department of Health show statistics that in most cases, patients consciousness is lost

within five minutes of swallowing the drug, but it could take one minute to even four days to die.


The average time is usually about twenty-five minutes. In Oregon, most patients who made the

decision to use the law are ninety-eight percent white and eighty-one percent were battling some

form of cancer. Fifty-two percent of patients were male and the average age of those using the

Death with Dignity laws were seventy-one years old. The top three end of life concerns with the

patients were stated as, “loss of autonomy, loss of dignity and the fact that they were less able to

engage in activities making life more enjoyable.” Most of these patients were enrolled in hospice

and had private insurance. Since Washington laws were accepted, one-hundred thirty five people

have died from the lethal dose of the prescription. Massachusetts wants to get the Death with

Dignity law passed and approved, however the Catholic Church has no interest in the topic and

believes, “Our society will be judged by how we treat those who are ill and infirm…They need

our care and protection, not lethal drugs.” Conflicting, it’s the people of the state that ultimately

get to make the decision on what the law’s fate will be, not the Catholic leaders, lawmakers or

even professionals in health care. Dr. Marcia Angell, former editor of Massachusetts Medical

Society’s New England Journal of Medicine, weighs in on the subject with her own opinions

stating, “I am less concerned with what doctor’s want than with what patients want. I think

doctors sometimes have a too-narrow idea of what their own obligations are. They feel they have

an obligation to extend life even when it can’t be extended significantly. And even if you have

that situation, then it seems to me they have two obligations. One is to support the autonomy, the

self-determination of their patients. And the other is to relieve suffering. If you can’t extend life

significantly, then you must relieve suffering.” In today’s society, people are living longer and

longer than ever before which makes the questions that come along with the topic of end-of-life

much harder to think about with families. (Death with Dignity National Center, 2014.)


Doctor’s Role in Assisted Dying

An Oregon citizen, Peggy Sutherland, was ready to end her life when it came to the pain

that came along with her lung cancer. Sutherland, “needed so much morphine to help with her

pain that it could actually cause her to go unconscious,” her daughter, Julie, claimed. Sutherland

decided to use Oregon’s Death with Dignity laws. On the fifteenth day, the doctor and her

husband met her at the pharmacy and they all went back home with her until her heart stopped

beating, “she didn’t want to wait any longer.” Doctors’ role in the law is to prescribe the

medicine along with the other qualifications that are stated previously, but not all doctors are on

board with the Death with Dignity law and choose to not have anything to do with it. Doctor Lisa

Lehmann, director of the Center for Bioethics at Brigham and Women’s Hospital in Boston as

well a professor at Harvard Medical School says, “Prescribing a lethal medication with the

explicit intent of ending life is really at odds with the role of the physician as a healer.”

(compassionandchoices.org). According to the American Journal of Hospice and Palliative Care

in 2008, more than two-thirds of American doctors object to physician-assisted suicide. Lehmann

also adds, “I believe patients should have control over the timing of death if they desire. And I

suggest rethinking the role of physicians in the process so we can respect patient choices without

doing something at odds with the integrity of physicians.” Although, Barbara Coombs Lee,

president of the Denver nonprofit Compassion and Choices disagrees with Lehman and quotes

that, “Patients deserve to have their physician accompany them there and not walk away.

Anything that improves access to assisted dying is a step forward, but I think shepherding

patients through their final days is a huge part of a physician’s responsibility.” (Compassion &

Choices, 2012).


The Story of Brittany Maynard

Before Maynard decided to use the Death with Dignity law to end her life, she was a

volunteer with the Compassion and Choices organization where she was an advocate for end-of-

life choices. For Brittany, it all started on New Year’s Day, headaches that caused her to not be

able to participate in her daily activities and little did she know that these headaches would

change her life. An aggressive brain cancer, glioblastoma, had taken over Maynard’s body and

was spiraling out of control. There was no cure for this cancer, and no treatments that could keep

her from dying. Brittany Maynard had less than six months to live and she had only been married

to her husband for just over a year. She was twenty-nine years old when the diagnosis came and

she and her husband wanted to start a family of their own. The cancer shot down all their

opportunities, causing Brittany to spend consecutive days in the hospital. Just nine days after the

cancer diagnosis, Maynard underwent surgery, a partial craniotomy and a partial resection of her

temporal lobe. These surgeries were to help the tumor to stop growing. April came around and

Brittany and her family heard the worst news they could every think of…the tumor came back. It

came back bigger and more aggressive than ever causing the doctors to give her a prognosis of

only six months of life to live. The doctors wanted to try full brain radiation due to the tumor

being overwhelmingly large in size. The side effects included that Brittany’s hair on her scalp

would “singe off,” and “be covered with first-degree burns.” The quality of life as Brittany

Maynard knew it as, was over. Months went by and after extensive research, Brittany and her

family came to a conclusion that nothing was going to save her life. There were no treatments

left, only ones that would end any time left she had to live. One thought of Maynard’s was to

pass away in hospice care at home where she lived in San Francisco, but she learned that with

palliative medication, she would eventually develop morphine-resistant pain. This would cause


other side effects like personality changes and even cognitive, verbal and motor loss. This

answer to her belief, was the definition of suffering and she didn’t want her family to see her

“suffer,” until she passed away. After researching about Death with Dignity, Maynard made her

decision that she will use the law to end her life if the “dying process becomes unbearable.” She

had all the qualifications to use the law except she did not live in a state that approved of it.

Since she decided it was ultimately the best option for her and her family, they moved from

California to Oregon because Oregon is one of the states where the Death with Dignity law is

authorized. Maynard had to find all new doctors, establish a residency in Portland, Oregon, find

a home, get a new Driver’s License, change her voter’s registration and find people who would

be in charge of her and her husband’s animals. Her husband, Dan Diaz, had to take a leave of

absence from his job during this process. Once all was in place, Maynard got her hands on the

medication that will end her life when she decides to ingest it. She held onto the medicine for a

while, for she does not want to die, she is “not suicidal,” but she is dying and “wants to do it on

her own terms.” Brittany Maynard didn’t want to change anyone’s opinion on whether or not

they should choose to use the law if they are in the position to do so, she simply just wanted

people to know that no one has the right to tell her, or anyone that they don’t deserve their own

choice. Through using the law, she wanted people to know that no one deserves to suffer for

periods of time in any amount of pain whether is physical, mental and/ or emotional. She claimed

that even though she has the medication in hand, there is a chance that she may choose not to

take it, it’s simply a “sense of relief,” to just have it in her possession because it takes away the

senses she had of pain, fear and uncertainty that she otherwise would have if she didn’t have the

prescription. Maynard claims that now she is at peace with enjoying the remainder of time she

has left to spend time with her loved ones, doing things she’s always wanted to do. Maynard’s


one goal was to celebrate her husband’s birthday with him, on October 26, 2014 and then choose

to end her life on a day soon after the celebration, “unless her condition improves dramatically.”

Brittany Maynard decided to ingest the prescribed barbiturates on November, 1st 2014 to

end her life. Just as she wanted, Maynard passed away in her bedroom on the second floor with

her mother, stepfather, husband and her best friend right by her side. She dreamed of dying

peacefully and said, “I can't imagine trying to rob anyone else of that choice.” Before her passing

she stated, “I hope for the sake of my fellow American citizens that I'll never meet that this

option is available to you. If you ever find yourself walking a mile in my shoes, I hope that you

would at least be given the same choice and that no one tries to take it from you.” (Life News,

2014).

Conclusion

Terminally ill patients face a huge predicament in how to live their last days of life while

living on the edge of almost torture and pain. While some are willing to brave nature and face a

slow death, others really wish for faster and less painful methods to die. Physicians may assist

such persons to end their lives by administering life ending medication to these patients. There

are many ethical reasons that are opposed to any physician assisted suicides. Similarly, there are

several ethical reasons that support this procedure. “Some of these ethical reasons include liberty

interest, dignity in death, cost benefit analysis and proper legislation to guide the already

prevalent practices.” (Death with Dignity National Center). Additionally courts have not

expressly decided that it is illegal simply providing guideline on the matter. In conclusion,

legalizing Physician assisted suicide will go far in maintaining the dignity of the patient and

other ethical aspect as discussed in this paper.

References


Boyce, J. (2012, July 16). Compassion & Choices: The evolving state of physician-assisted

suicide. Retrieved from https://www.compassionandchoices.org/tag/death-withdignity-

act/page/2/

Death with Dignity National Center. (2014). Retrieved from

http://www.deathwithdignity.org/access-acts

Kelly, D., Magill, G., & Ten Have H. (2013). Contemporary catholic health care ethics (2nd ed.).

Washington, DC: Georgetown University Press.

Life News. (2014). Suicide Prevention or Suicide Assistance: The tragic story of brittany

maynard. Retrieved from http://www.lifenews.com/2014/11/11/suicide-prevention-or-

suicide-assistance-the-tragic-story-of-brittany-maynard/

https://www.compassionandchoices.org/tag/death-withdignity-

http://www.lifenews.com/2014/11/11/suicide-prevention-or-

http://www.deathwithdignity.org/access-acts

Documents

Death with Dignity paper